Mal J Nutr 22(2): v - vi, 2016

INVITED EDITORIAL

Parental Attributes in Young Child Feeding Practices

The threat of overweight and obesity among children is alarming, both in high-income and low-income countries. Worldwide, about 10% of children are overweight and obese (Lobstein et al., 2004). Yet, the classic nutritional problem among toddlers, i.e., stunting, remains high especially in low-income countries. In ASEAN countries, the prevalence of stunting is 31.4% while that of obesity is 8.1% among children below 5 years of age. Indonesia and the Philippines have the biggest share of nutritional problems in light of their large populations (ASEAN & UNICEF EAPRO, 2016). For example, for Indonesia with about 25 million children aged below 5 years, obesity, estimated at 11.9% in this age group, amounts to almost 3 million children under 5 years (Ministry of Health, 2013).

Globally, studies show that nutrition accounts for one-third of the problem of stunting while the remaining two-thirds are non-nutrition factors (Bhutta et al., 2008). Studies showing the relative contributions of nutrition and non-nutrition factors for obesity are lacking. However, diet has been implicated as the most important factor leading to obesity. Thus, for both stunting and obesity, diet is an important modifiable factor.

Diet should fulfill the requirements of an individual or population group for healthy living. Good quality diet may arbitrarily be defined as a diet that includes unrefined cereals, minimally processed foods, vegetables and fruits, whole grains, healthy fats and healthy sources of protein. In this context, dietary diversity is key to a good quality diet for healthy growth in children (Busert et al., 2016). Dietary diversity is determined by food preference, which is defined by Howkes et al. (2015) as what people would select to eat at any one time from available options in a free-choice environment. Parents play an important role in influencing young children’s food preferences and intake. Generally, parents decide what foods will be prepared for their children. Studies among Dutch children (Zeinstra et al., 2009) show that parents use different strategies for increasing consumption of fruits compared to vegetables. While more pressure is exerted on children to consume more vegetables, children are given choices to consume more fruit. In both situations, a high intake of fruit and vegetables of the parents is also important in being role models and for providing a positive environment.

As for young children who are dependent on others to feed them, responsive feeding is crucial for children to have an adequate intake of healthy foods. Responsive feeding promises short- and long-term effects on habitual intake of healthy foods for children, such as increased attention to internal signals of hunger and satiety, to eating in a competent and responsible manner and subsequently to healthy nutrition and growth (Black & Aboud, 2011). A responsive care-giving environment was found beneficial to the development of children in low- and middle-income populations in Pakistan (Yousafzai et al., 2016). Monterrosa et al. (2012) provide evidence that women or mothers/care-givers have highly organised knowledge about child feeding based on cultural themes of ensuring good health, nutrition and growth. The organised knowledge of mothers is the cognitive scaffolding for what and how to feed young children that leads to an understanding of food choices. Thus, the parental factor is central for the establishment and upkeep of a good quality diet for children.

Siti Muslimatun PhD
Department of Food Science, Indonesia International Institute for Life Sciences (i3L),
Jakarta, Indonesia

REFERENCES

ASEAN & UNICEF EAPRO (2016). Regional report on nutrition security in ASEAN - Volume I. ASEAN Secretariat, Jakarta.

Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, Haider BA, Kirkwood, B, Morris SS, Sachdev HPS, Shekar M & Maternal and Child Undernutrition Study, Group (2008). What works? Interventions for maternal and child undernutrition and survival. Lancet 371: 417-440.

Black MM & Aboud FE (2011). Responsive feeding is embedded in a theoretical framework of responsive parenting. J Nutr 141: 490-494.

Busert LK, NEuman M, Rehfuess EA, Dulal S, Harthan J, Chaube SS, Bhandari B, Costello H, Costello A, Manandhar DS & Saville NM (2016). Dietary diversity is positively associated with deviation from expected height in rural Nepal. J Nutr 146: 1387-1393.

Hawkes C, Smith TG, Jewell J, Wardle J, Hammond RA, Friel S, Thow AM & Kain J (2015). Smart food policies for obesity prevention. Lancet 385: 2410-2421.

Lobstein T, Baur L, Uauy R & IASO International Obesity Task Force (2004). Obesity in children and young people: a crisis in public health. Obes Rev 5 (Suppl. 1): 4-85.

Ministry of Health Republic of Indonesia (2013). Basic Health Research Riskesdas 2013 (Riset Kesehatan Dasar Riskesdas 2013).

Monterrosa EC, Pelto GH, Frongillo EA & Rasmussen KM (2012). Constructing maternal knowledge frameworks. How mothers conceptualise complementary feeding. Appetite 59: 377-384.

Yousafzai AK, Obradoic J, Rasheed MA, Rizvi A, Portilla XA, Tirado-Strayer N & Siyal S, Memon U (2016). Effects of responsive stimulation and nutrition interventions on children’s development and growth at age 4 years in a disadvantaged population in Pakistan: a longitudinal follow-up of a cluster-randomised factorial effectiveness trial. Lancet Global Health. http://dx.doi.org/10.1016/S2214-109X(16)30100-0.

Zeinstra GG, Koelen MA, Kok FJ, van der Laan N & de Graaf C (2009). Parental childfeeding strategies in relation to Dutch children’s fruit and vegetable intake. Public Hlth Nutr 13(6): 787-796.

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